- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.00 / $1,543.90 / $8,229.00
| Facility | | $1,032.00 | $1,543.90 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,049.25 / $7,288.00 / $11,863.26
| Facility | | $5,049.25 | $7,288.00 | $11,863.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.58 / $1,628.65 / $1,878.76
| Facility | | $1,186.58 | $1,628.65 | $1,878.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.98 / $1,422.98 / $1,422.98
| Facility | | $1,422.98 | $1,422.98 | $1,422.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $2,513.00 / $27,879.00
| Facility | | $405.00 | $2,513.00 | $27,879.00 |